Fri Aug 19

From tough love to interventions, what works when a loved one is struggling with addiction?

Written by: Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin University

There’s some pretty bad advice out there for families impacted by alcohol and other drug use. Some of it not only doesn’t work but could actually make things worse.

Most people who use alcohol or other drugs never develop a problem ^[1] with it, and most people who develop problems recover ^[2]. If you discover someone in your family is using drugs, don’t panic or jump to conclusions. Getting angry or upset may mean they just hide their drug use.

So what can you do and what should you avoid if you discover a family member has an alcohol or other drug problem?

‘Tough love’

“Tough love” is treating someone harshly with the intention of reducing unwanted behaviour. For example, refusing to pick them up from a party if they are drunk, locking them out of the house if they don’t go to rehab, or refusing money for food if they are still using.

The problem is tough love doesn’t work for most people and, worse, it can cause more harm than good.

Sometimes it’s a well-intentioned attempt to set boundaries or protect against perceived “manipulation”. But it is often used out of frustration, anger or desperation, or driven by stigma about alcohol or drug use.

The problem is it is humiliating and demeaning, and can lead to feelings of guilt and shame. It can increase stress and sends the message the family’s love is conditional, which can result in more drug use, not less.

It is sometimes a misguided strategy to help someone to hit “rock bottom” so recovery can begin. But the idea someone needs to hit rock bottom before they will change is a myth ^[4].

It’s not true people must ‘hit rock bottom’ in order to change. Priscilla du preez/unsplash, CC BY ^[5]

We know from behavioural psychology that punishment and harsh treatment do not lead to long-term change ^[6]. Motivation to change comes when the benefits of giving up outweigh the benefits of using alcohol or other drugs.

A great piece of advice comes from one of our colleagues who is a carer of someone with a drug problem and also provides support for other families: do what you would do if drugs were not involved. If your child was struggling with another health issue, like a depression or anxiety, would you withhold money, lock them out of the house or refuse to speak to them if they didn’t want to seek help?

‘Enabling’

Families are sometimes accused of “enabling” drug use if they don’t use the tough love approach. Enabling is behaviour that is seen to protect someone from the consequences of their alcohol and other drug use.

The problem is it’s impossible to know what is helpful and what is enabling until the outcome is known.

Families may draw criticism if they take action that is helpful for them, but that outsiders see as enabling. You might remember the criticism levelled at the father of footballer ^[7] Ben Cousins when he revealed that he went with his son to buy drugs because he was so worried he would die.

When families are criticised for their attempts to help, it increases stress ^[9] in the family and can make the situation worse.

Enabling is merely a cliche that doesn’t help families work out what is helpful and unhelpful for them.

Staging an ‘intervention’

The “intervention” is a familiar scene in movies and on TV: concerned family and friends ambush their family member to get them to change.

There is some therapeutic basis ^[10] to this idea. It was originally designed as a caring conversation within the family, coached by a professional facilitator.

There is some evidence that it increases the likelihood of someone going to treatment ^[11], but reduces the likelihood they will stay there and increases likelihood of relapse.

When families stage their own intervention, the likely outcome is shame and embarrassment, and relationships can be damaged.

Think about desired outcomes

Families tend to intervene for two main reasons: to help the person using alcohol or other drugs to change their behaviour, or to improve wellbeing for the broader family.

Working out which of these is the priority can help the family get on the same page about the best approach.

It can be helpful to think about harm reduction. All or nothing goals, like complete abstinence, may not be achievable in the short term. So focusing on reducing behaviours that are harmful to the individual or the family might be more feasible. What can the family live with, even if it is not a perfect solution?

Agree on acceptable boundaries

When family members disagree about the best approach it can cause additional conflict and stress in the family. Setting realistic boundaries everyone agrees on and that are easy to maintain means they are more likely to be adhered to.

A good start is to think about boundaries that focus on positive action (like providing food) rather than only thinking about boundaries that focus on negative actions (refusing to provide money) or that only come into play when something goes wrong.

Boundaries that aim to reduce the family’s stress are also helpful, no matter how small. For example, putting the phone on “do not disturb” after a certain time so they can get some sleep.

When deciding how to intervene in a loved one’s dependence issues, think about the desired outcome. Priscilla du preez/unsplash, CC BY ^[13]

Improving communication

Families with alcohol or other drug problems do better when general communication in the family improves.

Focusing on reducing conflict and improving communication ^[14] has benefits for both the family and the person using alcohol or other drugs.

Look after yourself

Discovering drug use in the family can be a confusing and upsetting time. It may also come with additional unexpected worries, like care of grandchildren. As a result, families can experience poorer physical and mental health.

Family members need to look after themselves to be in a good position to provide support for the person using alcohol or other drugs and the rest of the family. It’s important to get enough sleep, eat well, and exercise regularly.

Consider the supports the whole family might need. Being around supportive family and friends can be helpful. Support groups provide help from others going through a similar situation. Families might also need professional support from a family therapist to figure out what is and is not working in their current approach and what they might do differently.

If you are worried about your own or someone else’s alcohol or other drug use, contact the National Alcohol and other Drug Hotline on 1800 250 015 for free, confidential advice. Family support is available from a number of organisations including APOD Family Support ^[16], Family Drug Support ^[17] and Family Drug Help ^[18] in Australia, and Family Drug Support ^[19] in Aotearoa New Zealand